With nearly $2 million in medical bills for my son already in his 10-year life span, I’ve learned a few things along the way about how to handle medical bills. I’ve learned what to pay, how not to pay what I really don’t owe, and how to resolve hanging issues out there regarding bills I thought my insurance should have covered.
The truth is that insurance companies are in the business of making money. This also includes pharmacies, doctor’s offices, lab services and any other kind of medical vendor. Less than scrupulous companies make money when you pay bills you don’t really owe. If you pay it, there is a small chance you will get it back after following a long process; that is if you don’t give up along the way.
Here are some tips to saving your money on the front end and ensuring your insurance company provides you what they promised and that vendor providers don’t overcharge you.
1. Before you pay a bill to a provider (doctor’s office, lab, hospital, durable medical equipment provider, pharmacy, place of therapy, etc.), check your booklet of coverage. If you didn’t think you were supposed to owe anything, chances are you don’t. If you have checked your coverage and still have questions, it’s time to pick up the phone and call your insurance provider (sigh and ugh… here we go).
- Be prepared to document all details of every phone call. Date, time, name of person, date of service for the bill in question; and a reference number for your phone call and any other details discussed with your customer service representative.
- When you call, you will reach a low-level phone answerer who usually has a script. They have no real authority other than to initiate a “review” of your charge.
- If your issue wasn’t resolved within 30 business days, you may have to call them again. If there is no progress after sharing the above information regarding the last time you called, ask for a supervisor.
- Tell the supervisor you wish to begin the appeal process. They may try to avoid passing you up to a supervisor. Keep asking and pressing until you move at least one level up.
- You might have to put your appeal to the charge in writing. Be sure to include in your letter all pertinent information, as well as your expectation to receive their appeal decision within 30 business days (sometimes they will try to push you to 30, 60 or 90 days, meanwhile things may be headed to hit your credit rating). Typically these get resolved in about 10 business days, and I can call the provider right back to offer them the update from my insurance company. The vendor will usually will keep it out of collections at this point.
2. Ask the insurance company if the vendor should have put the bill through another billing code so that they will pay it. They should tell you if it was billed correctly or what code the vendor should have used when sending it to your insurance company in the first place (in my case, this cleared up about 30-40% of the incorrect billing issues).
3. Double check with the provider. Be sure they checked your insurance and the amount due is based on what your insurance plan is supposed to provide. Ensure they billed it using the proper medical billing code. And they owe you an itemized bill, not just a blanket dollar figure. Ask for the itemized bill and compare it to your EOB (Explanation of Benefits) from your insurance company.
4. Should you receive notice from a vendor that your outstanding balance is about to be sent to a credit collection agency, immediately call your insurance company and ask for the supervisor. Let them know this bill is about to be sent to collection. They will expedite your review and handle it. They are legally obligated to resolve the issue before this happens. And typically vendors will make a note to keep it out of collections, as these usually resolve between vendor and insurance company within about 10 days.
5. If you do not receive the answer you want from your insurance company, ask for the supervisor’s supervisor. Keep going up until you get to where you need to get to in order to resolve the issue.
6. If your insurance company has withheld multiple payments from a vendor, continue to keep your bills on a no-payment schedule and then you can contact your state’s insurance board. I have written my insurance company with complete attached documentation and sent it at the same time to my state insurance board for review. “Miraculously” my issues escalated that high were immediately resolved with the insurance company. When insurance companies are reported to the state insurance board, they can be fined heavily for lack of proper payments. They do NOT want to be reported nor audited by the state insurance board. I keep this one in my pocket for the BIG things or ongoing issues, as I don’t want to overdo it and become bothersome. You don’t want to be ignored by the people who can really get the job done when it really matters.
If you can’t resolve the matter before this bill will be sent to a credit collection agency, you can make payment arrangements to pay the bill. Offer up the lowest amount you can afford per month, so that you can keep working towards resolution with the vendor and you maintain your credit worthiness. As long as you are making progress on the bill, the vendor won’t send you to collection.
So what about the pharmacy? They too, will overcharge you, and often it’s not on purpose. Often they are not fully trained on software or versed on coverage. The biggest mistake I run into here is due to the face that my son has Medicaid as a secondary insurance. So if any of you out there have a secondary insurance and you are being asked to pay something that you don’t think you owe, here are a few tips.
- Tell the pharmacist or pharmacy tech to first run it through your primary insurance so they can deny the coverage. THEN, you can enter the secondary insurance, which will cover the medication.
- Double check with your secondary insurance about what they are supposed to cover. Likely they will simply confirm what you already know about your coverage, but it will give you additional information (and ammunition) to use with your pharmacy.
- If they still have trouble, you may have to ask for the pharmacy manager. Often they are the best versed at using the software, and properly entering things so that they ring up correctly.
Dealing with these issues can be incredibly stressful. Sometimes it will take more than four phone calls and three hours on the phone to resolve a single bill. So prepare yourself mentally. Take a deep breath, count to ten, and don’t take it out on the person on the phone. Be firm and persistent, but not emotionally charged. If you get frustrated, take a quick walk, grab a coffee, do some jumping jacks or anything to calm your nerves and get back on that horse. It will take some persistence to just get this done and taken care of. But Momma, you are NOT alone, and you can do this.